SKEPTOID BLOG:

Smallpox Inoculation Debate of 1721

If you remember Cotton Mather from history class, you probably know him as the villain behind the 1692 witchcraft trials in Salem, Massachusetts. In fact, Mather also deserves credit as one of early America's most prolific intellectuals and as the first American advocate in favor of inoculation, a historical method for smallpox prevention and a precursor to the modern vaccine.

The story of inoculations in Boston is one of the most underappreciated in American lore. Rife with scandal, tragic missteps, and an attempted murder, the tale lacks only a car chase scene. It even features a young Ben Franklin. So hold onto your seats, folks.

Cotton Mather wrote over 400 books and pamphlets in his lifetime. Unfortunately, his major contribution to the field of medicine is a minor footnote to his stint as an expert on the occult. Biographer Kenneth Silverman observed that Mather lingers in the backdrop of American literature as a "National Gargoyle [...] bigoted, superstitious, authoritarian, and devious."

A supernatural drama now airing on WGN, Salem, depicts Mather as the primary witch hunter and executioner in Salem. When the witch trials occurred, Mather was 29-years-old and too ill to attend any of the proceedings. Even so, Mather wrote about the trials, simultaneously criticizing and encouraging them, and historians argue that Mather's 1689 book, Memorable Provinces, fueled the witchcraft panic. But it wasn't until the inoculation debate of 1721 that Mather's role in the trials became a topic of discussion.

By the 17th century, smallpox inoculation was a common practice in Turkey and in parts of Africa. Inoculations were also common in China, originating during the 10th century, and in India as early as 8th century. Mather first heard of inoculation from his slave, Onesimus, who had been inoculated as a child, most likely in West Africa. Significantly, Mather recorded Onesimus' account verbatim, including dialect. In the following years, Mather apparently set to work gathering inoculation accounts from African slaves residing in Boston.

In 1716, Mather sent Onesimus' account, along with his subsequent notes on similar inoculation practices in Turkey, to the Royal Society, a London scientific organization. Mather's account may have contributed to the popularization of smallpox inoculation in England and the colonies.

Unfortunately, little is known about Onesimus' life. He was married with at least two children, one or both of whom died in 1714. Mather described Onesimus as "a pretty intelligent Fellow," and freed him in 1716 under the condition that Onesimus remain available to shovel snow and carry firewood for the Mather household upon request. For more information on Onesimus and slavery in Puritan New England, see Kathryn S. Koo's paper, Strangers in the House of God.

Mather's interest in smallpox inoculation was both altruistic and personal. During the measles epidemic of 1713, Mather lost his wife and three of his children. Mather had observed that beginning in 1630, smallpox had devastated Boston exactly every 12 years. His son Samuel was attending Harvard in 1721 when his roommate died of smallpox. Terrified of the contacting disease, Samuel moved back into his father's house.

Mather became eager to introduce inoculation in the colonies. He drew up a pamphlet directed to Boston physicians. Only one, Dr. Zabdiel Boylston, initially responded. Dr. Boylston, the owner of an apothecary shop, had garnered acclaim for his surgical removal of a large stone from a 13-year-old boy's bladder. He would go on to successfully perform one of the first mastectomies on American soil.

The process of inoculation described in Turkey involved puncturing a pox on a young, healthy person with a mild case of smallpox and sealing the fluid in a clean jar. The doctor made small incisions on the inoculee's arm muscle, applied a few drops of infected fluid to each cut, then covered the incision with a walnut shell or other concave object (Boylston would switch to a warmed cabbage leaf later). Reports stated that the inoculee may develop 10 to 20 pustules that would dry and fall off. No deaths were reported and scarring was rare.

Boylston immediately inoculated two slaves, a 36-year-old man and a two-year-old child, along with his own six-year-old son. Only minor pustules occurred on the children, and all three recovered quickly. Boylston and Mather began advertising inoculations in newspapers and inoculating volunteers without permission from the Board of Selectmen, early Boston's governing body.

A vicious public debate on the ethics and potential dangers of inoculation followed Boylston's experiments. A few ministers sided with Mather and Boylston, but most Bostonians were outraged. Opponents of inoculation had a variety of objections.

Most physicians questioned the safety and efficacy of inoculation, and challenged the idea of medical practitioners purposefully infecting healthy people. Some said inoculation did little to prevent the disease and was more likely to make it spread faster. They worried that an epidemic of the bubonic plague that had surfaced in France would propagate more rapidly among those who had been inoculated.

Medically trained anti-inoculators attempted to downplay the severity of the epidemic and exaggerated the effects of inoculation, claiming it caused ulcers and loss of limbs, and led to higher mortality rates than letting the disease run its course.

The chief anti-inoculator was Dr. William Douglass, the only formally educated doctor in Boston at the time. Douglass, referring to Boylston's "dangerous quack Advertisement" for inoculation, designated Boylston "ignorant" and "illiterate," and decried Mather for listening to "Old Greek Women" and black people. He went on to exclaim: "There is not a Race of Men on Earth more False Lyars, &c. Their Accounts of what was done in their Country was never depended upon till now for Arguments sake . . . O Rare Farce!" Douglass later confided in a private correspondence that he didn't record his medical observations on smallpox because it was "more natural to begin by reducing my small-pox accounts into bills and notes for the improvement of my purse."

Boylston's experimental inoculations occurred in June of 1721. By August, the public outcry against Mather and Boylston had found a venue in the newly established New-England Courant, a newspaper founded by the young printer James Franklin. The Courant was the first American newspaper to feature satirical and literary pieces, thanks in part to James's little brother, the 16-year-old Ben Franklin.

The New-England Courant marked the death of the Puritan city on a hill, which had been on the decline since the 1680s. Essays published in the Courant openly mocked the old order of ministers and selectmen, and the paper was widely circulated among unusually literate New Englanders.

Columnists attacked Mather and Boylston, bringing the Salem witch trials back into the public eye. Harvard historian, Perry Miller, wrote in the 20th century that "the intellectual history of New England up to 1720 can be written as though no such thing [as the Salem witch trials] ever happened," meaning that the trials were all but forgotten until the smallpox controversy called Mather's judgment, along with New England's system of religious governance, into question.

A tobacconist named John Williams disseminated pamphlets accusing Mather of using his religious status to claim medical expertise that he did not possess. Williams cited Mather's ambiguous, "superstitious" position on the use of spectral evidence and traced the pattern of ministerial meddling to the persecution of Quakers. Under the original charter, which allowed the Puritans to establish their own laws, Quakers were subject to amputations and execution for venturing into Boston. King Charles II specifically prohibited this in 1661. Douglass also called attention to some of Mather's natural philosophy, such as his descriptions of phantom sightings and his theory that pigeons migrated to an invisible satellite of Earth.

Mather's career never recovered from the barrage of criticism he received as a result of his efforts to normalize inoculation, though Boylston went on to become wealthy and internationally revered. In November, someone threw a grenade into Mather's home with a note attached: "COTTON MATHER, You Dog, Dam You; I'l inoculate you with this, with a Pox to you." The grenade was damaged when it went through the window, and the fuse did not catch. No one was injured. Mather was used to criticism by this time, and he recorded his regret at the missed opportunity for martyrdom in his diary.

In March of 1722, Ben Franklin began printing letters in The New-England Courant under the pseudonym on "Mrs. Silence Dogood," a clear allusion to Mather's Bonifacius: Essays to Do Good (1710). The Silence Dogood letters mimic Mather's flowery language and habit of "scribbling," while mocking his passive-aggressive, judgmental style and use of pseudonyms to covertly praise his own work.

Franklin mentions Bonifacius in his autobiography in a vague, characteristic line: "[Another] of Dr. Mather's, called Essays to do Good [...] perhaps gave me a turn of thinking that had an influence on some of the principal future events of my life." Though the Silence Dogood letters were clearly poking fun at Mather, Franklin apparently admired the man and his writing. After a falling out with his brother, who was initially unaware of Silence Dogood's true identity, Franklin ran away to Philadelphia.

By April of 1722, a total of 5,889 people had been infected with smallpox, with a death toll of 844. Smallpox was responsible for over three quarter of deaths in Boston in 1721. Boylston had inoculated 242 people, only six of whom had died; witnesses suspected that the six had contracted smallpox before being inoculated or died of something unrelated. 14 percent of Bostonians who caught smallpox died, while only two percent of those inoculated did not recover. In the coming years, inoculation would become more accepted, leading up to Edward Jenner's work developing a cowpox vaccine in the 1770s.

Childhood mortality was incredibly common in Mather's time. Puritan theologians advised against parents forming strong attachments to their children, perhaps because their chances of living to the age of twenty-five were so slim. Of the fifteen children that Mather fathered, only two outlived him, and he never stopped grieving for his offspring. Mather's diary abounds with references to dead and dying children. This is why Mather pushed for inoculation, even in the face of attempts on his life. He wrote of inoculating his son, Sammy, who had begged to be an early recipient, that he "could not answer it unto God, if I neglected it."

In a letter to the Royal Society, Mather hypothetically wondered if anti-inoculation scientists had "no dread at all of being accessory to the Innumerable Deaths which may be, in part, owing to their boisterous Opposition [to inoculation]." Cotton Mather believed wholeheartedly in witchcraft, and he seems to have spent considerable lengths of time pondering the exact location of the heavenly pigeon planet, but he was on the right side of history when it came to inoculation. Death and illness associated with preventative inoculations and vaccines have gone from a dubious two percent in 18th century Boston to less than one in a million today, with only one death "even possibly associated with a vaccine." History's lesson is clear, but it has a way of repeating itself nonetheless.